Upstream, Downstream

Geoff Girvitz· February 28, 2025 · 3 min read

I’m honestly surprised that I haven’t run across miasma truthers yet.

Miasma, if you don’t live in a Charles Dickens novel, was the theory that contagious diseases, like bubonic plague, cholera, and even chlamydia, were born out of poisonous, foul-smelling vapours. This one had been around since the ancient world and was still the prevailing belief in early to mid-19th century England.

I would describe miasma theory as one of those things that is fine if you follow it as a rule of thumb but utterly dangerous to take seriously. Our sensitivity to bad smells, after all, is not an evolutionary fluke–and avoiding stinky things like sewage and rotting food is sensible. Certainly not harmful. There’s strong correlation, in other words, but not much in the way of causation.

That’s why it would feel very ala mode for someone to be posting on social media about how it’s so simple—”Can’t you see how the global elites are hiding the miasma from you!?” This would be followed up with a thousand emotionally-compelling anecdotes. It's this kind of near-miss that conspiracy theorists seem to gobble up. Anyway, back to the inconvenient details of science and a very good story:

During a cholera outbreak in 1854 London, doctors believed the disease to be airborne. John Snow believed otherwise.

Wait, not this one:

This one:

The guy with the (superior) mutton chops is one of the founding fathers of epidemiology. While everyone else was shouting about miasma, Snow took pains to map out the outbreak. He found that this was an upstream/downstream problem.

Upstream was the Lambeth company intake. It drew its water from a clean-ish section of the Thames. And then there was the Southwark and Vauxhall Company intake, which drew water downstream of Lambeth and, more notably, a sewage outlet. You do the math. Snow did. He compared incidents of cholera in homes drawing water from each source and the numbers were clear.

Here’s a picture of the Broad Street Pump responsible for dispensing cholera-laced water. Snow removed the handle and the rest is history. If only things could always be that simple.

There are still places in our lives where we can avoid problems simply by moving upstream. Most of these problems involve willpower and decision-making. Just like we don’t want to have to agonize over whether every single cup of water is safe to drink, we also don’t want to spend 1.21 gigawatts of mental energy (or feel sick to our stomach later) when it comes to health decisions.

From an infrastructure standpoint, that means voting and advocating for anything that supports public health and thoughtful policy.* From a personal standpoint, not much changes. Here, you make deeply considered decisions—based on priorities, values, and a pragmatic understanding of your own abilities. And then you build systems that minimize day-to-day decisions.

Some examples:

• Automated investment
• What foods you always or never have at home
• Making walking or biking your go-to mode of transportation for certain routes
• Committing to an activity that provides at least one weekly dose of open, healthy conversation

And…

• I would be remiss in not advising you to lock into an exercise program.

That last one you saw coming. Over and above membership, we’ve got two bonus ways to get this done at Bang:

1. Lock into our Full-Year Resolution program
2. Look to apply your benefits with our integrated physiotherapy-Group Personal Training at Bang

Email info@bangfitness.com with “Physio Q” if you want details

*No comment on recent political events.

Upstream and away,
GG

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